Pediatric Radiology

, Volume 43, Issue 9, pp 1152–1158 | Cite as

Paraphyseal changes on bone-age studies predict risk of delayed radiation-associated skeletal complications following total body irradiation

  • Mary T. Kitazono HammellEmail author
  • Nancy Bunin
  • J. Christopher Edgar
  • Diego Jaramillo
Original Article



Children undergoing total body irradiation (TBI) often develop delayed skeletal complications. Bone-age studies in these children often reveal subtle paraphyseal changes including physeal widening, metaphyseal irregularity and paraphyseal exostoses.


To investigate whether paraphyseal changes on a bone-age study following TBI indicate a predisposition toward developing other radiation-associated skeletal complications.

Materials and methods

We retrospectively reviewed medical records and bone-age studies of 77 children receiving TBI at our institution between 1995 and 2008 who had at least 2 years of clinical follow-up and one bone-age study after TBI. We graded bone-age studies according to the severity of paraphyseal changes. All documented skeletal complications following TBI were tabulated. Kendall’s tau-b was used to examine associations between degree of paraphyseal change and development of a skeletal complication.


Kendall’s tau analyses showed that physeal widening and metaphyseal irregularity/sclerosis (tau = 0.87, P < 0.001) and paraphyseal exostoses (tau = 0.68, P < 0.001) seen on bone-age studies were significantly positively associated with the development of delayed skeletal complications following TBI. Thirty percent of children with no or mild paraphyseal changes developed a delayed skeletal complication, compared with 58% of children with moderate paraphyseal changes and 90% of children with severe paraphyseal changes.


Paraphyseal changes identified on a bone-age study correlate positively with the development of delayed skeletal complications elsewhere in the skeleton following TBI.


Bone age Exostoses Total body irradiation Periphyseal Children 


Conflicts of interest



  1. 1.
    Miyazaki O, Nishimura G, Okamoto R et al (2009) Induction of systemic bone changes by preconditioning total body irradiation for bone marrow transplantation. Pediatr Radiol 39:23–29PubMedCrossRefGoogle Scholar
  2. 2.
    Faraci M, Barra S, Cohen A et al (2005) Very late nonfatal consequences of fractionated TBI in children undergoing bone marrow transplant. Int J Radiat Oncol Biol Phys 63:1568–1575PubMedCrossRefGoogle Scholar
  3. 3.
    Bielack SS, Rerin JS, Dickerhoff R et al (2003) Osteosarcoma after allogeneic bone marrow transplantation. A report of four cases from Cooperative Osteosarcoma Study Group. Bone Marrow Transpl 31:353–359CrossRefGoogle Scholar
  4. 4.
    Faraci M, Banasco F, Corti P (2009) Osteochondroma after hematopoietic stem cell transplantation in childhood. An Italian study on behalf of the AIEOP-HSCT group. Biol Blood Marrow Transplant 15:1271–1276PubMedCrossRefGoogle Scholar
  5. 5.
    Fletcher BD, Crom DB, Krance RA et al (1994) Radiation-induced bone abnormalities after bone marrow transplantation for childhood leukemia. Radiology 191:231–235PubMedGoogle Scholar
  6. 6.
    Marcovici PA, Berdon WE, Leibling MS (2007) Osteochondromas and growth retardation secondary to externally or internally administered radiation in childhood. Pediatr Radiol 37:301–304PubMedCrossRefGoogle Scholar
  7. 7.
    Bordigoni P, Turello R, Clement L et al (2002) Osteochondroma after pediatric hematopoietic stem cell transplantation: report of eight cases. Bone Marrow Transpl 29:611–614CrossRefGoogle Scholar
  8. 8.
    Leach C (1979) Introduction to statistics: a nonparametric approach for the social sciences. Wiley, New YorkGoogle Scholar
  9. 9.
    Donaldson SS (1992) Effects of irradiation on skeletal growth and development. In: Green DM (ed) Late effects of treatment for childhood cancer. Wiley-Liss, New York, pp 63–70Google Scholar
  10. 10.
    Murphey MD, Choi JJ, Kransdorf MJ et al (2000) Imaging of osteochondroma: variants and complications with radiologic-pathologic correlation. Radiographics 20:1407–1434PubMedGoogle Scholar
  11. 11.
    Taitz J, Cohn RJ, White L et al (2004) Osteochondroma after total body irradiation: an age-related complication. Pediatr Blood Cancer 42:225–229PubMedCrossRefGoogle Scholar
  12. 12.
    Claikens B, Brys P, Samson I et al (1998) Spontaneous resolution of a solitary osteochondromas. Skeletal Radiol 27:53–55PubMedCrossRefGoogle Scholar
  13. 13.
    Fink JC, Leisenring WM, Sullivan KM (1998) Avascular necrosis following bone marrow transplantation: a case–control study. Bone 22:67–71PubMedCrossRefGoogle Scholar
  14. 14.
    Socie G, Cahn JY, Carmelo J et al (1997) Avascular necrosis of bone after allogenic bone marrow transplantation: analysis of risk factors for 4,388 patients by the Societe Francaise de Greffe de Moelle (SFGM). Br J Haematol 97:865–870PubMedCrossRefGoogle Scholar
  15. 15.
    Enright H, Haake R, Weisdorf D (1990) Avascular necrosis of bone: a common serious complication of allogeneic bone marrow transplantation. Am J Med 89:733–738PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Mary T. Kitazono Hammell
    • 1
    Email author
  • Nancy Bunin
    • 2
  • J. Christopher Edgar
    • 1
  • Diego Jaramillo
    • 1
  1. 1.Department of RadiologyThe Children’s Hospital of PhiladelphiaPhiladelphiaUSA
  2. 2.Oncology Division, BMT SectionThe Children’s Hospital of PhiladelphiaPhiladelphiaUSA

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